The following is the summary of “Effect of high-flow oxygen versus T-piece ventilation strategies during spontaneous breathing trials on weaning failure among patients receiving mechanical ventilation: a randomized controlled trial” published in the December 2022 issue of Critical care by Lee, et al.
Whether a patient is ready for extubation by conducting a spontaneous breathing experiment (SBT) is decided, although the optimal SBT selection procedure is still up for debate. Researchers compared the success rates of weaning off mechanical ventilation between patients who used high-flow oxygen versus T-piece ventilation techniques during SBT. Patients at a single medical ICU who had been on mechanical ventilation for >12 hours and met weaning readiness criteria were enrolled in this randomized clinical trial from June 2019 to January 2022. T-piece SBT or high-flow oxygen SBT was randomly assigned to each patient. Weaning failure on day 2 was the major outcome, whereas weaning failure on day 7, length of stay in the intensive care unit and the hospital, and patient morale were secondary outcomes.
About 64 patients were given T-piece SBT, and 64 were given high-flow oxygen SBT, for 108 patients (mean age 67.0± 11.1 years; 64.8% men). On day 2, weaning failure occurred in 5 (9.3%) of patients in the T-piece group and 3 (5.6%) in the high-flow group (difference, 3.7% [95% CI, -6.1-13.6]; P=0.713). Failure to wean by day 7 occurred in 13 patients in the T-piece group (24.1%), while it happened in 7 patients in the high-flow group (13%; difference, 11.1% [95% CI, -3.4-25.6]; P=0.215). Post hoc subgroup analysis of patients intubated due to respiratory failure found that high-flow oxygen SBT was substantially linked with a decreased probability of weaning failure on day 7 (OR, 0.17 [95% CI, 0.04-0.78]).
Length of stay in the intensive care unit (ICU), overall hospital stay, and mortality rates was similar across the 2 groups. No major adverse events occurred during the trial. High-flow oxygen SBT did not significantly lower the likelihood of weaning failure compared to T-piece SBT in patients requiring mechanical ventilation. However, a higher proportion of patients with simple weaning and a lower weaning failure rate than expected should be considered when interpreting the findings, and the study may have been underpowered to detect a clinically important treatment effect when comparing high-flow oxygen SBT to T-piece SBT.